Learn about front-line clinical informatics, clinical workflow design, and EMR implementation with an experienced CMIO. Open discussion is encouraged, education is a priority. All opinions are strictly my own.

Thursday, November 19, 2015

Hi readers,After my last post, some people asked me if I could put it into a video form, to help share with other people.I was able to condense it into this 7-minute, 23-second video below.So for anyone who has ever struggled to explain the Informatics domain, how it is related to clinical workflow development, and how it can help create smooth, predictable, reliable, and non-disruptive workflows - I offer up the following :

Hope it was helpful! Leave your comments and feedback in the comments section below!

Wednesday, November 18, 2015

For today's post, I'd like to offer some insight about two common questions I get - What is clinical informatics, really? And just how is informatics related to workflow development in the EMR world?

So to really answer these questions, I'd like to propose three goals for this post :

To describe how operational tools and workflows are developed and directed in an organization.

To describe the informatics domain.

To demonstrate how the informatics domain is vital in developing and directing workflows in the electronic (EMR) realm.

And by accomplishing those goals, I hope I can offer some insights into how to build a successful informatics platform. So, let's start off with a diagram I have lovingly named the "operations pyramid" :

I created this diagram to help explain how predictable operations are created. First, let's look at two important features of the diagram :

At the top is the Mission/Vision - This is essential for setting the tone and direction of the organization, creates goals and targets, and is necessary to align the rest of the operations with successful outcomes. Typically, senior leadership has the responsibility for defining this very important part of the operations pyramid.

At the bottom is the Organizational Support - Because nothing happens in an organization without good support.

Between these two parts of the pyramid are a number of steps which all build on each other to predictably support the Mission/Vision of an organization. First - From the bottom-up, let's step through them - The :

Organizational Support (needed for everything) helps create the...

Concepts (or in Informatics lingo,Ontologies) which shape the fundamental understanding and principles that the the organization uses to function, which then supports the...

Definitions / Terminology / Standards the organization uses to write and speak predictably to each other, which then support the...

Templates / Archetypes the organization uses to support the creation of predictable...

Documents / Tools which the organization uses to support the...

Workflows / Processes the organization needs to support the ...

Goals / Regulations the organization seeks to support the ...

Mission / Vision of the organization.

Even when it's not fully appreciated, every organization has this pyramid at work, creating predictability and infrastructure - or not, if it's not well-understood.

This brings us to the Informatics domain, and why it's suddenly become an important part of operations in the EMR world. Informaticists are people who work to create predictable outcomes by focusing their attention on parts 3-7 of this pyramid :

So to be successful at creating predictable workflow/process outcomes (#3), Informaticists must also concern themselves with steps 4-7.

Now, keep in mind that the part that's most visible in most organizations - the traditional documents/tools (deliverables) that we think of as 'what we need to operate' (e.g. documentation, order sets, etc) - is really only step 4 in this pyramid :

So you'll notice that in the entire Informatics domain, these documents/tools that are seen as the traditional deliverables are only small piece of the domain :

... and so conflicts can arise if it's not well-understood :

...that these deliverables are only a piece of the entire Informatics domain, and

... the depth/breadth of these of deliverables.

So to better understand the challenges organizations may face when developing a successful Informatics framework, let's look at this line #4 (Documents/Tools) in a little more detail, and see how it related to workflow development.

To create workflows that are smooth, predictable, reliable, and non-disruptive, requires a significant amount of deliverables - The list continues to grow as technology advances. One common source of confusion : Only some of them are inside the EMR, which is another potential source of conflict for the Informaticist who is seen as only needing to occupy their time with the 'EMR issues'. So let's look at these deliverables in more detail :

In the above slide, I've largely separated the workflow deliverables into :

The ones generally outside the EMRare ones that are traditionally seen as the responsibility of other departments, such as quality, nursing, IT, HR, or finance. (e.g. policies/procedures, guidelines, interfaces, schedules, etc.)

The onesgenerally inside the EMRare ones that are traditionally seen as the responsibility of Clinical IT/informatics departments (e.g. clinical documentation, orders, order sets, etc.)

The ones that span both(largely the emerging workflow technology which is created to help automate clinical workflow management).

The challenge that some organizations face in developing a successful informatics platform, however, is the understanding that whether they are inside the EMR or outside the EMR, or both - These deliverables all impact workflow.

So to avoid conflict, it's important to consider breaking with tradition, and developing a newer governance model which integrates your informatics leadership with the leadership of these other departments (e.g. quality, nursing, IT, HR, and finance). If the workflows that the organization needs depends on all of the deliverables, together, then it's important that the leaders of all of these areas work together to manage these deliverables as a team.

And this is why informatics should not be confused with IT, tech support, or 'whatever's inside the EMR' - Workflow success depends on the integration of leadership from all of these areas, to ensure that the organization can build and fully support the workflows that are needed to support their operational goals and vision.

I hope this post has been helpful to you! Leave any comments or feedback in the comments section below!